Romanian Neurosurgery (Dec 2015)
Evaluation of the clinical efficiency of transforaminal epidural steroid injection in the treatment of sciatica
Abstract
Objective: Evaluation of clinical efficiancy of fluoroscopy-accompanied transforaminal epidural steroid injection in patients with symptomatic lumbar foraminal intervertebral disc herniation and foraminal stenosis. Methods: Fifty patients, who underwent fluoroscopic-guided epidural steroid injection between 19.12.2013 - 28.02.2014, were evaluated retrospectively. Pain levels of patients before the procedure, after 3 weeks and after 6 months were compared using visuel analog scale (VAS). Fifty percent or more decrease, less than 50% decrease and no change in VAS were evaluated as sufficient response, insufficient response and unresponsiveness, respectively. The patients were asked whether they would undergo this process again and “Yes”, “Maybe” and “No” answers were evaluated for patient satisfaction score. Results: In 50 patients (32 female, 18 male), average pain levels were found to be 8.4 (VAS 7-9), 4.3 (VAS 1-9) and 4.4 (VAS 0-9) before the procedure, 3 weeks after the procedure and 6 months after the procedure, respectively. While thirty-seven (74%) of the patients were found to have sufficient response to treatment 3 weeks after the procedure, 10 (20%) patients were found to have insufficient response. There was no response to treatment in 3 (6%) patients. While thirty-five (70%) of the patients were found to have sufficient response to treatment 6 months after the procedure, 10 (20%) patients were found to have insufficient response. Six months after the procedure, there was no response to treatment in 5 patients (%10). Statistically significant improvement was observed when the pre and post-procedure VAS scores were compared. Forty (80%) patients gave the answer “Yes” to the question whether they would undergo this procedure again. Conclusion: We found that fluoroscopic guided transforaminal epidural steroid injection is effective in pain relief in patients with lumbar foraminal intervertebral disc herniation and foraminal stenosis that are resistant to pharmacological and physical therapy and have no absolute indication for surgery.
